Heart and Vascular Institute, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania 15213, USA.
JACC Cardiovasc Interv. 2011 Oct;4(10):1085-92. doi: 10.1016/j.jcin.2011.07.011.
The aim of this study was to evaluate the efficacy of regadenoson, in comparison with adenosine, for assessing fractional flow reserve (FFR) of intermediate coronary artery stenoses (CAS).
Fractional flow reserve is an established invasive method for assessing the physiological significance of CAS. Regadenoson, a selective A(2A) receptor agonist, is an approved hyperemic agent for pharmacological stress imaging, but its role for measuring FFR is unknown.
This prospective, single-center study enrolled 25 consecutive patients with intermediate CAS discovered during elective angiography (25 lesions). In each patient, FFR of the CAS was measured first by IV adenosine (140 μg/kg/min), followed by IV regadenoson (400 μg bolus). The intrapatient FFR correlation between adenosine and regadenoson was evaluated.
The mean age was 63 ± 11 years, and mean left ventricular ejection fraction was 58 ± 11%. Most patients were male (52%) and had hypertension (84%) and dyslipidemia (84%), with 24% having diabetes mellitus and 20% chronic obstructive pulmonary disease. The CAS was visually estimated during angiography (mean 58 ± 9%) and most often found in the left anterior descending coronary artery (48%). A strong, linear correlation of FFR was noted with adenosine and regadenoson (r = 0.985, p < 0.001). A hemodynamically significant lesion (FFR ≤ 0.80) was present in 52% with no reclassification of significance between adenosine and regadenoson. No serious events occurred with administration of either drug.
Our results suggest that a single IV bolus of regadenoson is as effective as an intravenous infusion of adenosine for measuring FFR and, given its ease of use, should be considered for FFR measurement in the catheterization laboratory.
本研究旨在评估瑞加德松（regadenoson）与腺苷相比评估中间冠状动脉狭窄（CAS）的血流储备分数（FFR）的疗效。
FFR 是评估 CAS 生理意义的一种已确立的有创方法。瑞加德松是一种选择性 A2A 受体激动剂，是一种用于药物应激成像的已批准的促充血剂，但它在测量 FFR 方面的作用尚不清楚。
这项前瞻性、单中心研究纳入了 25 例在选择性血管造影中发现的中间 CAS 连续患者（25 处病变）。在每位患者中，首先通过 IV 腺苷（140μg/kg/min）测量 CAS 的 FFR，然后通过 IV 瑞加德松（400μg 推注）测量。评估了腺苷和瑞加德松之间的患者内 FFR 相关性。
平均年龄为 63±11 岁，平均左心室射血分数为 58±11%。大多数患者为男性（52%），患有高血压（84%）和血脂异常（84%），24%患有糖尿病，20%患有慢性阻塞性肺疾病。CAS 在血管造影期间进行了目测评估（平均 58±9%），并且最常发生在前降支冠状动脉（48%）。FFR 与腺苷和瑞加德松之间存在很强的线性相关性（r=0.985，p<0.001）。在 52%的患者中存在血流动力学显著狭窄（FFR≤0.80），但在腺苷和瑞加德松之间没有意义的重新分类。两种药物的使用均未发生严重不良事件。
我们的结果表明，瑞加德松的单次 IV 推注与静脉内输注腺苷一样有效，用于测量 FFR，并且鉴于其易用性，应考虑在导管实验室中用于 FFR 测量。
